A newly-released study on early adoptees of the Primary Care Network initiative proposes that their success lies with three key elements: strong leadership, a redefined, inclusive workspace and allowance for creative discord.

In a paper published in Health Care Management Review, lead researcher Trish Reay of the Alberta School of Business and colleagues from the U of A, University of Calgary and Florida Atlantic University state that of eight centres that agreed to the government proposal to design and deliver comprehensive family health care, five were able to thrive by engaging in and adopting changes in standard practice.

Reay says that this reorganization of patient care into more comprehensive services reaps positive benefits for all parties - the patients, the doctors and other healthcare practitioners involved in the networks, and the healthcare system itself. And with over 2500 doctors now signed on the initiative, it is a system that holds promise for improved healthcare delivery in the province.

"What the doctors I've spoken to find attractive about the PCN model is, that by bringing other professionals and creating a team, it allows the physicians to practice medicine in the way they really want to," she said.

Follow the leader: healthcare managers guide successful integration

Reay noted that healthcare managers who were hired to organize the PCNs were an important catalyst of change. They facilitated group decision-making regarding the re-organization and re-allocation of work, such as counseling diabetes patients on lifestyles, from doctors to other healthcare professionals, such as nurses. The physicians were able to focus on the aspects of the practice for which they were solely qualified. Under this framework, the care and treatment of patients truly became a team approach.

"We found that the managers had to find ways to get the physicians and those around them to actually try these new, multidisciplinary mechanisms," said Reay. "These managers had a positive attitude and they set up a number of different ways that almost made them keep trying it for awhile. As they kept trying it, they made them talk about it and really think through how it was going."

Communication, space key components

Reay says that a re-organization and re-allocation of physical space was critical in developing teamwork and facilitating communication. But, the ability to communicate - and to disagree - also seemed to make the successful PCNs. Those who had not made successful transition were pleasant, but she said they constantly claimed to be "almost ready" to make the change, a sign that perhaps hid underlying communications issues. Those leaders that had managed the difficult conversations and found the ability to compromise and move forward were models of success.

"(Managers) encouraged people to disagree so that you could have a more full discussion about what was going on and really think through how to manage it," she said.

PCNS provide benefit for all

Reay said the doctors she spoke with are sold on PCNs because they allow them greater freedom to practice medicine the way they want, provide for maintained contact with their patients and offer them great work-life balance. As economic issues mean that healthcare has to do more with less, she says this model permits the PCNs to focus on healthcare needs of their patient community - areas such as mental health, diabetes, cardiac care, etc - and work preventatively providing counseling and information to people at-risk for chronic diseases.

"Patients actually like this model. They like the fact that they see their physicians still, but they don't have to rely on those quick office visits in order to ask questions and get more information and learn about whatever it may be that they have, said Reay. "In a business world, we'd say that this model is more 'user-friendly.'

"The client has a better and, I think, more effective experience in terms of learning to manage their own life and be healthy."

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